STD Triage: The App that no one wants to review 

June 17, 2013

By Alexander Börve

Worried about that rash “down there”. Hmm…it’s probably nothing, but that one-night stand two weeks ago without a condom is still in the back of your mind. Going to the doctor is too embarrassing and takes a lot of time.  It’ll probably just go away on it’s own…right? WRONG! Many of the 19 million Americans who discover they have an STD every year (in addition to the estimated 100 million Americans who live with an STD source: CDC) have probably had this thought before and could have avoided the anxiety and embarrassment early on, as well as avoided spreading the infection. Is there an app to help people overcome their embarrassment to see a doctor? STD Triage, is an app and website which provides discreet sexually transmitted disease (STD) screening assessments by licensed dermatologists within 24 hours via anonymous photos submitted by the user.  Approximately 70% of the cases are benign and are given self-treatment information, in 5% of cases, the user is advised to see a doctor in person right away to get a definitive diagnosis. The remaining 25% are advised to get STD tested.

Hello Android!

Today the service has released their Android app, which complements the already released iPhone and web apps which have been extensively covered by the press and featured on CNN as well as Wired among many others. The STD service launched in Marchas a spin-off from the original iDoc24 app where you can ask a dermatologist about any skin query anonymously. “The creation of the STD app was a good way for iDoc24 to penetrate the US market.” Dr Börve said. The iPhone app has had over 4000 downloads and up to 100 weekly cases from worried users. One happy anonymous user’s feedback was: “I used the service while on holiday, I was very satisfied with the service, the answer I received relieved my anxiety“. Users from 120 countries have downloaded the app so far, which is available in English, Spanish and Swedish. There are only four iTunes reviews out of the 4,000 downloads (all 5 stars), only one of them coming from the US.

Show Me Some Love

Why doesn’t anyone want to rate the app? Dr Börve explains that they did not think of creating an app with five star reviews that would go “viral”, but to help worried souls out there. There is a huge stigma around intimate worries; it is not something that you want to talk about with friends, or even with your partner, which without communication can in turn ruin a relationship. “You would think that the many relieved users would be happy to review the app and recommend the service. Dr Börve said. “However, reviewing an app might give away the user’s real identity and this topic is embarrassing, nobody wants to broadcast “What a great app! I was told I had herpes within 24 hours!” Dr Börve continues.

Growing Network

STD Triage has been contacted by several companies in the online STD Testing space. “We are currently working on several contracts to be announced soon. We have also received interest from university student health clinics and NGOs focused on sexual health and well being, we know we are moving in the right direction” Dr Börve said. An STD Triage infographic inclusive all of the statistics can be found here

 

Dating Sites for Individuals with STDs / STIs

May 28, 2013

By Kira Hoffman

 

Waiting at the doctor’s office for test results is a frightening ordeal for anyone. In the waiting room, many people may start to assume the worst, think of the future, or play out possible scenarios in their head as if their life is a Hollywood movie. These people may see their lives going one of two ways after the nurse gives them their results. #1: Their STD is curable, after taking the medication, they can resume their normal, day to day lives. #2: Their STD is not curable, it will affect them for the rest of their lives, creating numerous barriers and preventing lasting, loving relationships. In my previous blog posts I have discussed the ways in which stigma affects beliefs surrounding STDs. Although in retrospect, the waiting room experience may be viewed as a relief if one is diagnosed with a curable STI, it is important to understand that life-long STD’s such as Herpes can still be treated. As well, if you are diagnosed with an incurable STD, you can still have a life full of romantic love and good sex. Because the topic of STDs can be extremely difficult to broach with potential partners (see my previous article on stigma and shame) there are several dating sites available online that cater to individuals with STD’s. Online dating is a great way to interact with others and ‘break the ice’ before meeting someone in person. These STD-friendly dating sites allow those with incurable STD’s to connect with people who are in a similar situation. This can be especially helpful in erasing the stigma one may find when interacting with someone who doesn’t understand what it’s like to have an STD (although it is important to note that people with STD’s can/and do form loving and understanding connections with people who aren’t STD positive). Here is a list of dating sites built specifically for individuals living with STD’s:

Dating Site Options

1. PositiveSingles.com

http://www.positivesingles.com/ The “Positive Singles” slogan is, “Stay Positive! Find Love, Support & Happiness”. The site emphasizes the fact that each member is “not alone”. Members can be heterosexual or homosexual and you can join whether you are living with a curable or incurable STD. The site is free to join, although you have to pay a fee if you would like to contact others on the site.  

2. HMates.com

http://hmates.com/ “HMates” is a dating site specifically geared to individuals with Herpes and/or HPV. Members can be heterosexual or homosexual and when you create your account for free, you can choose to view other profiles located within a certain distance of yourself. The site is advertised as being “Norton Safe Web certified” and free to join, however to contact particular individuals you have to pay a monthly fee.  

3. GenitalWartsPatients.com

http://www.genitalwartspatients.com/home.php Not specifically advertised as a dating site, “Genital Warts Patients” is a Social Networking site. The site is advertised as a “supportive online community”. Accounts also appear to be free. If you have found yourself in a waiting room, contemplating your future based on test results, know that your potential for romantic and sexual relationships does not end with an incurable diagnosis. Dating sites and networking sites for people living with STD’s are always an option, and are definitely nothing to be ashamed about. They may even help you become more comfortable with your situation. Read full post

The Pre-Antibiotic Age: Not Ideal for Gonorrhea Infections

By Daniel Peixoto Irby

UCB-UCSF Joint Medical Program, MS Candidate 2013, MD Candidate 2015

 

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When I was a kid, my mother took me to visit her family in Brazil in years when we had time. There, I got into all sorts of scrapes, trips, and cuts, as kids do. When that happened, my grandmother, who grew up on a farm, would pin me down and paint this stinging stuff onto the affected area. Mertiolate, it was called there. I still remember its harsh-sounding name, its acrid smell, the sting, and the cooling after-sensation when my grandma would blow on my cut. Maybe you had a similar experience-- but this is probably not where we want to go back to if one of us or one of our friends, god forbid, were to come down with gonorrhea. Recent scientific reports indicate that it’s just a matter of time, unless new antibiotics are discovered that slow these dread bugs. Back before antibiotics, gonorrhea and many other infections were treated with things like mercurochrome-- I think we would all prefer to keep that a historical footnote.

The Age of Antibiotics

Antibiotics revolutionized the treatment of gonorrhea in the 1930s, but by the 1940s the sulfa class of antibiotics were increasingly ineffectual. This would turn out to be a harbinger of things to come. At the time, penicillin was quick to stem the tide, until the mid-1970s, when the critters cracked that nut. No sweat: we had fluoroquinolones. Some intrepid gonorrhea evolved into the oddly-named QRNG: Check (as in chess). (By now we’re resigned to the dismaying arc of the story.) In 2010, we were down to the futuristic-sounding cephalosporins. Guess what? Well, it’s not quite to the point where nothing works. But there are some disturbing trends, and some facts about which you should be aware. N. gonorrhoeae resistance to cephalosporins first emerged in East Asia in the early 2000s, then France (2009), Spain (2010), and recently CDC surveillance has indicated that cephalosporins are not working as well as they used to against gonorrhea in the US. This emergence has tracked along where previous QRNG emerged: Hawaii, California, and the rest of the western US, and especially in the populations of gay, bisexual, and other men who have sex with men. The idea to go back to some of the older antibiotics that were shelved in the fight against gonorrhea has been batted around, but resistance rates have been remeasured by CDC surveillance (who ever said the government never did anything for you?) and were found to be between 12 and 24 percent for various older antibiotics. This means that the days of going to a doctor and getting effective antibiotics on the spot for a gonorrhea infection are likely numbered. Some other facts to know are that effective treatment of gonorrhea now relies increasingly on the ability of the treating facility to have access to a laboratory that can do the appropriate cultures (gonorrhea is still cultured, as there are not yet any widely-available fancy tests like those used in diagnosing HIV). This is important to keep in mind if you or someone you know is seeking treatment for gonorrhea. A key reason for this is that research has suggested that antibiotic-resistant strains of gonorrhea, which we know are on the rise, will cause worse infections if left untreated-- that is, they are probably both harder to treat and worse for the infected individual.

Gohorrhea Basics

Some basics about gonorrhea: N. gonorrhoeae is a bacterium that thrives inside human cells, is transmitted sexually, and causes an infection often known as “The Clap” (from the French for brothel). Sexually-contracted gonorrhea most frequently infects the throat, the cervix, the urethra in both sexes (“the pee tube”), and the rectum. Rectal, throat, and cervical infections are often asymptomatic. About half of women and around 5 percent of men who are infected show no symptoms. When there are symptoms, they are burning with urination and penile discharge men, and pelvic pain and vaginal discharge in women. Gonorrhea can lead to infertility (in both sexes, but more commonly in women), increased risk of ectopic pregnancy (a life-threatening situation), increased risk of contracting HIV from sexual contact, and can even be fatal. With an estimated 700,000 new cases of gonorrhea in the US each year, and the rise of the nasty and the nastier strains of gonorrhea, this is something to keep your eye on.

References

CDC Grand Rounds: The Growing Threat of Multidrugg-Resistant Gonorrhea (February 013) (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6206a3.htm) LA Times: New 'superbug' strain of gonorrhea resistant to all available antibiotics; researchers fear global outbreak (July 2011) (http://articles.latimes.com/2011/jul/11/news/la-heb-antibiotic-resistant-gonorrhea-07112011) LA Times: Antibiotic-resistant gonorrhea discovered; are 'superbug' chlamydia, syphilis strains next? (July 2011) (http://articles.latimes.com/2011/jul/12/news/la-heb-bacterial-stds-20110712) Read full post  

HPV Vaccines: Not Just for Girls

May 9, 2013

By Daniel Peixoto Irby

UCB-UCSF Joint Medical Program, MS Candidate 2013, MD Candidate 2015

 

Back in 2006 when the FDA approved the HPV vaccine for girls, I remember wondering, “Why not vaccinate boys, too?” Although the FDA did subsequently approve the vaccine for use in males, it was not something that I heard much about. Which is why my eyebrows went up when I read that Australia has not only been having excellent uptake among girls and women for their HPV vaccination program, but has also, beginning February of this year, rolled out a national vaccination program for boys aged 14-15 (See the details from the Australian Cancer Council here). The quadrivalent vaccine (Guardasil, Merck) protects against four strains of HPV. Strains 16 and 18 cause 70 percent of cervical cancers in women, and strains 6 and 11 cause 90 percent of genital warts, overall. There is also a bivalent vaccine (Cervarix, GSK) that protects mainly against HPVs 16 and 18. Outright cervical cancer is not something we hear too much about in the US, in large part because the Pap smear is effective at catching precancerous changes that may precede cervical cancer.  But in regions of the world where screening is less readily available, cervical cancer is more common: between 3 and 7 times more common (relative to the US) in Sub-Saharan Africa, South America, and Southeast Asia, according to the WHO. Cervical cancer is perhaps the most preventable cancer -- and preventing cancer is something we should be all about. Read full post

Herpes: Real Talk

By Daniel Peixoto Irby

UCB-UCSF Joint Medical Program, MS Candidate 2013, MD Candidate 2015

 

A Doctor's Tricks

How doctors remember things is important-- but sometimes medical habits betray a troubling prudishness about sexual matters. Let’s talk about herpes, for example. As a medical student, I make friends with mnemonics (memory devices, such as GET SMASHED for the causes of pancreatitis, which includes “scorpion sting” for the curious). We have oodles of these things, from the memorable “S2, S3, S4 keep the penis off the floor”), to the ho-hum, “Tzanck heavens I don’t have herpes”-- but wait, the helpful reminder about the diagnostic utility of the Tzanck smear aside, what is up with that? Medical students don’t have herpes? I had some questions when I read that. For instance, how many people really have herpes, and what is the best way to prevent its spread (a natural question when you don’t just assume that people with herpes are shadowy, distant “others”)? Well, the fact is that herpes has been dubbed “The Hidden Epidemic.”

Herpes by the Numbers

First some quick background: HSVs (short for “herpes simplex viruses”) 1 and 2 cause oral and genital herpes (oral herpes is often called cold sores). HSV 1 is traditionally more likely to cause oral herpes while HSV 2 is traditionally more likely to cause genital herpes. However, each viral type can cause the other type of infection, and there is some evidence that HSV-1 is overtaking HSV-2 as the leading cause of genital infection. Read full post  

Why does society find STIs / STDs to be so scary?

By Kira Hoffman

 

Scary STIs

Why does society find sexually transmitted infections (STIs) to be so scary? The answer to this question partly has to do with the fact that much of society shames the open discussion of sex, therefore shaming any discussion of STIs even further. No sexually active person wants to feel like an outcast, and many people who are diagnosed with an STI feel this way. That’s a sad reality. The shame associated with having an STI is often the result of larger social stigmas that are perpetuated through everyday myths. Here are some common myths that perpetuate shame and stigma: Read full post  

Infographic - iDoc24 & STD Triage Customer Breakdown

By Radek Rybicki

We've compiled a quick breakdown of our customers, including:

• -Age distribution
• -Countries in which we have customers
• -Types of cases submitted
• -Gender distribution
• -Types of conditions identified by dermatologists

  See the infographic here  

The Stigma of STDs and STIs

By Kira Hoffman

The power associated with the fear of sexually transmitted infection lies in the fact that no particular class or location is safe from the dangers of unsafe sex. This is why STD prevention methods and awareness strategies are useful to sexually active individuals everywhere. Read more